Schizophrenia - CBT + Family therapy

Question 1

What is family therapy?

Answer 1

Based on the theory that there are poor relationships and communication between an individual with schizophrenia and their carers
E.g. hostile mother and passive father

10 sessions over 3-12 months

Question 2

What is the aim of family therapy?

Answer 2

To provide support for carers to make family life less stressful hence reducing schizophrenia.

Question 3

How does family therapy work?

Answer 3

• Aimed at reducing levels of EE and stress in the family
• Therapist forms alliance with both patient and carer
• Together they work out ways for the family to solve problems
• Psychoeducation: Helping person and carers to understand and better able to deal with the illness
• Reducing anger and guilt in family members
• Helping families achieve balance between own needs and the schizophrenic’s needs

Also used along side drug therapy (drugs can help calm down symptoms so they engage in therapy)

Question 4

What are the strengths of family therapy?

Answer 4

Support from evidence

• Reviewed evidence of effectiveness from 53 studies
• Found moderate evidence that therapy helped reduce hospital admissions and improved quality of life
• Compliance increased
• No difference in ability to live independently

High economic benefit

• Improvements in clinical, social and family functioning reduce the need for intensive medical and social care and so produce economic benefits
• Cost savings can be substantial
• The additional cost to the family is usually minimal, particularly as treatment sessions can be arranged flexibly to minimise loss of earnings or transport cost

Question 5

What is a limitation of family therapy?

Answer 5

• Study found no difference in relapse rate between families that had family therapy and those who didn’t
• Maybe modern families have greater understanding and empathy
• Tend to have low EE

Question 6

What is CBTp?

Answer 6

• Cognitive behaviour therapy for psychosis
• It is based on the idea that it is distorted beliefs which influence feelings and behaviour
• Based on the ABCDE model
• Challenges people’s beliefs and change them
• Around 16 sessions on a one-one basis
• Behavioural assignment (homework)

Question 7

What is the ABCDE model?

Answer 7

Activating event
Beliefs about A
Consequences of B
Dispute by therapist
Effect of dispute on B and C

Question 8

How does CBTp work?

Answer 8

Assessment: Therapist discusses individual’s current symptoms and origins. Once they’re known, realistic therapeutic goals are set
Engagement: The therapist empathises with the person’s distress
Normalisation: Placing the person’s psychotic experiences with normal experiences. If the client is told their experiences are common, they will feel less alienated and stigmatised
Critical collaborative analysis: Gentle empathetic and non-judgmental questioning helps the person understand their false beliefs.
Developing alterative explanations: Enables healthier explanations for beliefs and experiences. This is supported with help from the therapist if the personal has difficulty.

Question 9

What is a limitation of CBTp?

Answer 9

• Not everyone benefits from it
• It is not widely available and not routinely offered to patients
• Less than 1/10 patients who could benefit from CBTp receive it
• Some refuse or fail to attend therapy (lack insight)

Question 10

What research support is there for CBTp?

Answer 10

NICE review of research
Those treated with both drugs and CBTp had:
- Reduced readmission rates for up to 18 months following treatment
- Reduced symptom severity
- Improved social functioning

Reviewed 34 studies
- Found that CBTp has a highly significantly effect on both positive and negative symptoms of schizophrenia